Petra Koopmans

Effect of Early, Pre-Hospital Initiation of High Bolus Dose Tirofiban in Patients With ST-Segment Elevation Myocardial Infarction on Short- and Long-Term Clinical Outcome

OBJECTIVES The purpose of this trial was to study the effect of a high bolus dose (HBD) of tirofiban on clinical outcome in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). BACKGROUND The On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2) placebo-controlled, double-blind, randomized trial showed that early administration of HBD tirofiban in the ambulance improves ST-segment resolution in patients with STEMI undergoing primary percutaneous coronary intervention. The effect of early tirofiban treatment on clinical outcome is unclear. METHODS The On-TIME 2 trial consisted of 2 phases: an open-label phase, followed by a double-blind, placebo-controlled phase. STEMI patients were randomized to either HBD tirofiban or no tirofiban (phase 1) or placebo (phase 2) in addition to aspirin, heparin, and high-dose clopidogrel. The protocol pre-specified a pooled analysis of the 2 study phases to assess the incidence of major adverse cardiac events at the 30-day follow-up and on total mortality at the 1-year follow-up. RESULTS During a 3-year period, 1,398 patients were randomized, 414 in phase 1 and 984 in phase 2. Major adverse cardiac events at 30 days were significantly reduced (5.8% vs. 8.6%, p = 0.043). There was a strong trend toward a decrease in mortality (2.2% vs. 4.1%, p = 0.051) in patients who were randomized to tirofiban pre-treatment, which was maintained during the 1-year follow-up (3.7% vs. 5.8%, p = 0.08). No clinically relevant difference in bleeding was observed. CONCLUSIONS Early, pre-hospital initiation of HBD tirofiban, in addition to high-dose clopidogrel, improves the clinical outcome after primary percutaneous coronary intervention in patients with STEMI. (Ongoing 2b/3a inhibition In Myocardial infarction Evaluation; ISRCTN06195297).

Frequent and long-term absence as a risk factor for work disability and job termination among employees in the private sector

Objectives: Frequent and long-term absentees were monitored over 5 years with regard to the risk of work disability and job termination. Methods: A prospective longitudinal cohort study in 53 990 employees of Dutch postal and telecommunications companies. In the first year of the study, employees who were absent four times or more (frequent absentees; n = 4126), for 6 weeks or more (long-term absentees; n = 3585), and combined frequent and long-term absentees (n  =  979) were distinguished, together with a reference population consisting of 45 300 employees. The disability rate (defined as the number of employees who were absent for >1 year per 100 employee-years) and the risk of job termination were determined over a period of 4 years. Results: In the reference population, women had a higher disability rate (2.2 per 100 employee-years) than men (0.8 per 100 employee-years). Frequent absentees had a disability rate amounting to 2.5 per 100 employee-years in men and 4.2 per 100 employee-years in women. Long-term absentees had a disability rate of 6.7 per 100 employee-years in men and 9.1 per 100 employee-years in women. Combined frequent and long-term absentees had an even higher disability rate. The risk of employment being terminated (involuntarily) was higher in prior absentees as compared with the reference population (RR = 1.2–2.1 for job termination and RR = 1.5–2.5 for involuntary job termination). In men, absences due to neoplasms, mental disorders and respiratory disorders were associated with an increased disability risk as compared with musculoskeletal disorders. Neoplasms and mental disorders were also associated with a higher risk of job termination in men, whereas infectious and neurological diseases were associated with a higher risk of job termination in women. Conclusions: Prior frequent and/or long-term absentees show high work disability in a 4-year follow-up period. Moreover, they are at higher risk of (involuntary) job termination.

Effort–reward imbalance is associated with the frequency of sickness absence among female hospital nurses: A cross-sectional study

BACKGROUND Most research on sickness absence among nurses has focused on long-term work disability. Absence from work due to short-term sickness, however, is more common and frequent short absences result in understaffing and increased workload of nursing teams. OBJECTIVES To investigate health and work factors in relation to the frequency of short-term sickness absence among nurses. DESIGN A cross-sectional study linking self-reported health and work factors to the frequency of registered sickness absence episodes in the preceding 3 years. SETTINGS A regional hospital in the Dutch province Friesland employing 1153 persons. PARTICIPANTS 459 female nurses working at least 3 years in the clinical wards (n=337) or the outpatient clinic (n=122) of the hospital. METHODS Perceived general health, mental health, demand/control (DC) ratio, workplace social support, effort/reward (ER) ratio, and over-commitment (i.e. the inability to withdraw from work obligations) were assessed by a self-administered questionnaire. The associations between the questionnaire results and the registered number of sickness absence episodes were analysed by negative binomial regression analysis, distinguishing between short (1-7 days) and long (>7 days) sickness absence episodes and controlling for age, hours worked, and duration of employment. RESULTS 328 (71%) female nurses completed their questionnaires and of these 291 were eligible for analysis. High frequent absentees perceived poorer health, had lower over-commitment scores, and reported higher ER-ratios than low frequent absentees. Esteem rewards were related to sickness absence whereas monetary rewards were not. Feeling respect from the supervisor was associated with fewer short sickness absence episodes and respect from co-workers was associated with fewer long sickness absence episodes. CONCLUSIONS Effort-reward imbalance was associated with frequent short sickness absence episodes among nurses. Work efforts and rewards ought to be potentially considered when managing nurses who are frequently absent from work as these factors can be dealt with by managers.

Trends in the incidence of sickness absence due to common mental disorders between 2001 and 2007 in the Netherlands

BACKGROUND Mental disorders are an important public health problem because of their prevalence and the probability of long-term work disability. The incidence of sickness absence with mental disorders has increased between 1985 and 2000, but little is known about trends in recent years. This study investigated the incidence of sickness absence due to common mental disorders in the Netherlands from 2001 to 2007. METHODS Observational study in about 1 million employees, working in various economic sectors, representative for the Dutch workforce. Sickness absence episodes were medically certified by an occupational physician utmost in the fifth week of absence. The 12-month incidence of medically certified sickness absence was calculated for each year by dividing incident episodes by the number of employees. Sick days due to common mental disorders were computed as percentage of the total number of medically certified sick days. RESULTS The 12-month incidence of sickness absence due to common mental disorders was 2.2% in 2001, increased to 2.7% in 2004 and decreased thereafter to 2.0% in 2007. The percentage of sick days due to common mental disorders was highest in the education sector (39%) followed by financial services (31%) and health care (30%). CONCLUSIONS In the Netherlands, the incidence of sickness absence with common mental disorders was highest in 2004 and has decreased since then probably because of changes in sick leave compensation, economic market position and company policies.

Sickness absence and full return to work after cancer : 2-year follow-up of register data for different cancer sites

Objective: Cancer survival has improved in recent years, but data on return to work (RTW) after cancer are sparsely published. Therefore, this study analysed RTW after cancer.

The history of registered sickness absence predicts future sickness absence

BACKGROUND The history of sickness absence has been found to predict future sickness absence. AIMS To establish the review period of historical sickness absence data that is needed to predict future sickness absence. METHODS The individual number of days and episodes of sickness absence were ascertained for 762 hospital employees from 2004 to 2008 inclusive. Past sickness absence was included stepwise in ordinal regression models. The explained variance of the ordinal regression models reflected the extent to which future sickness absence could be predicted and was expressed in percentages calculated as Nagelkerkes pseudo R(2) × 100%. RESULTS A total of 551 employees (72%) had complete data and were eligible for regression analysis. Days of sickness absence in the past year predicted up to 15% of future days of sickness absence. Adding the sickness absence data of the past 2 or 3 years did not further increase the predictability of days of sickness absence. Episodes of sickness absence in the past year predicted up to 25% of future episodes of sickness absence. The predictability of episodes of sickness absence increased to 30% when the past 2 years of sickness absence were included in the regression model, but did not further increase when sickness absence of the past 3 years was included. CONCLUSIONS Employees who are more likely to have an above average sickness absence can be identified from their history of sickness absence in the past 2 years.

Gender and age differences in the recurrence of sickness absence due to common mental disorders: a longitudinal study

BackgroundCommon mental disorders (CMDs) are an important cause of sickness absence and long-term work disability. Although CMDs are known to have high recurrence rates, little is known about the recurrence of sickness absence due to CMDs. The aim of this study was to investigate the recurrence of sickness absence due to CMDs, including distress, adjustment disorders, depressive disorders and anxiety disorders, according to age, in male and female employees in the Netherlands.MethodsData on sickness absence episodes due to CMDs were obtained for 137,172 employees working in the Dutch Post and Telecommunication companies between 2001 and 2007. The incidence density (ID) and recurrence density (RD) of sickness absence due to CMDs was calculated per 1000 person-years in men and women in the age-groups of < 35 years, 35-44 years, 45-54 years, and ≥ 55 years.ResultsThe ID of one episode of CMDs sickness absence was 25.0 per 1000 person-years, and the RD was 76.7 per 1000 person-years. Sickness absence due to psychiatric disorders (anxiety and depression) does not have a higher recurrence density of sickness absence due to any CMDs as compared to stress-related disorders (distress and adjustment disorders): 81.6 versus 76.0 per 1000 person-years. The ID of sickness absence due to CMDs was higher in women than in men, but the RD was similar. Recurrences were more frequent in women < 35 years and in women between 35 and 44 years of age. We observed no differences between age groups in men. Recurrences among employees with recurrent episodes occurred within 3 years in 90% of cases and the median time-to-onset of recurrence was 11 (10-13) months in men and 10 (9-12) months in women.ConclusionsEmployees who have been absent from work due to CMDs are at increased risk of recurrent sickness absence due to CMDs and should be monitored after they return to work. The RD was similar in men and in women. In women < 45 years the RD was higher than in women ≥ 45 years. In men no age differences were observed.

Job satisfaction and sickness absence : a questionnaire survey

BACKGROUND When dissatisfaction with work precedes sickness absence, screening for satisfaction levels might usefully detect workers at risk of sickness absence. AIM To investigate whether job satisfaction was associated with subsequent sickness absence days or episodes. METHODS A sample of workers was randomly drawn from a population of employees who had an episode of absence between January and April 2003. Job satisfaction was measured using a validated single question with a Likert-type scale ranging from 1 (very dissatisfied) to 7 (very satisfied). Job satisfaction levels were linked to the number of recorded sickness absence days and episodes in 2003, distinguishing between short (1-7 days) episodes and long (>7 days) episodes. RESULTS Of 898 questionnaires distributed, 518 (58%) were returned. The mean+/-standard deviation job satisfaction level was 5.1+/-1.4 and negatively related to the number of sickness absence days. Job satisfaction was also negatively related to the number of short episodes and long episodes of absence, but these associations were not significant. CONCLUSIONS Job satisfaction was significantly related to total sickness absence duration. The association with the number of sickness absence episodes was weak and just below the level of statistical significance. Assessing work satisfaction levels might usefully identify those workers most likely to have the greatest sickness absence duration.

Risk of future sickness absence in frequent and long-term absentees

BACKGROUND Prior absence is an important predictor for sickness absence, but little is known about the recurrence among frequent and/or long-term absentees, over a longer period of time. AIM To monitor sickness absence among frequent and long-term absentees in order to investigate their risk of recurrent absence. METHODS Longitudinal cohort study in employees working in three large Dutch postal and telecommunications companies. In the first year of study, we distinguished employees who were absent four times or more (frequent absence), employees who were absent for >or=6 weeks (long-term absence), combined frequent and long-term absence and a reference population. The absence rates in these groups were followed-up for 4 years. RESULTS The study population (n = 53,990) comprised 4126 frequent absentees, 3585 long-term absentees, 979 combined frequent and long-term absentees and a reference population (n = 45,300). Frequent absentees had a higher risk of recurrent frequent absence when compared to the reference population, with rate ratios (RR) amounting to 4.9 [95% confidence interval (CI) 4.7-5.1] in men and 3.2 (95% CI 3.0-3.4) in women. They also had a higher risk of developing long-term absence: RR = 1.9 (95% CI 1.8-2.0) in men and 1.5 (95% CI 1.4-1.6) in women. Long-term absentees had high risk of recurrence: RR = 1.9 (95% CI 1.8-2.0) in men and RR = 1.4 (95% CI 1.3-1.5) in women. CONCLUSIONS Employees with prior frequent and/or long-term absence were at risk of recurrent absence. Frequent absence was a prognostic factor predicting future long-term absence.

Marked reduction of early stent thrombosis with pre-hospital initiation of high-dose Tirofiban in ST-segment elevation myocardial infarction.

Summary.  Background: No randomized comparisons are yet available evaluating the effect of pre‐hospital high dose tirofiban on the incidence of early stent thrombosis after primary percutaneous coronary intervention (PCI). Objectives: The aim of this analysis was to evaluate whether routine pre‐hospital administration of high‐dose tirofiban in ST‐segment elevation myocardial infarction (STEMI) decreases the incidence of early stent thrombosis after primary PCI. Patients/methods: The Ongoing Tirofiban in Myocardial Evaluation (On‐TIME) 2 trial was a prospective multicenter study of consecutive STEMI patients referred for primary PCI in which patients were randomized to pre‐hospital no high‐dose tirofiban/placebo. We examined the incidence of Academic Research Consortium definite and probable early stent thrombosis and determined predictors and outcome of early stent thrombosis. Results: Primary PCI was performed in 1203 out of 1398 patients (86.1%). In 1073 patients (89.2%) a coronary stent was placed. Early stent thrombosis occurred in 39 patients (3.6%). Pre‐hospital initiation of high‐dose tirofiban significantly reduced early stent thrombosis (2.1% vs. 5.2%, P = 0.006) and was associated with a lower incidence of urgent repeat PCI (1.9% vs. 5.2%, P = 0.005). Early stent thrombosis, as well as pre‐hospital initiation of high‐dose tirofiban, was independently associated with 30‐day mortality. Conclusions: Pre‐hospital initiation of high‐dose tirofiban reduces the 30‐day incidence of stent thrombosis in STEMI patients treated with primary PCI and stenting. Early stent thrombosis and pre‐hospital initiation of high‐dose tirofiban were independent predictors of 30‐day mortality.